The Clinical Application Of Flaps In Repairing Tissue Defects Of Extremities With 62 Cases

ObjectiveLimb trauma, tumor excision, burns, infection, scar removal, which may cause skin and soft tissue defect and varying degrees of blood vessels, nerve, tendon and bone exposed. Flap, due to its characteristics, has become the primary means of surgical wound healing and proper selection of flap has been a long-term concern of this field. This study focused on the application of random-pattern flaps, axial pattern flaps and free flaps of 62 cases with varying degrees of skin and soft tissue defect, based on the principle of concerning both function and appearance of the redevelopment range as well as reducing the damage loss. Flap should be selected in accordance with each individual case so as to get the best treatment for different position and different tissue defect to further clarify various types of flap application of the best indications and to sum up the causes for skin flap complications and treatment measures taken to improve the flap survival rate and maximum extent of limb function and form of repair, hence to provide reference for clinical treatment.Methods62 subjects collected with skin flap limbs:1) to choose a suitable flap donor site based on the guidelines and condition of patients; 2) to design appropriate flap according to the wound size; 3) to select the same size of a flap as the subject area with the separation of axis cardiovascular based on its anatomy; 4) to cover the wound range with a selected random flap, or a pedicle or free flap; 5) to close up the wound of donor directly or with transplantation of a free skin graft or a variety of skin flap.ResultsIn the 62 cases collected,53 cases received 3 to 8 months follow-up after treatment since 9 patients could not be tracked down (no address information).2 cases of venous vascular crisis occurred, of which one suffered skin edge necrosis and healed after a secondary skin graft, and the other survived after an emergency treatment.24 cases of flap with slightly bloated appearance and slightly different skin colors, also with satisfying flexibility and recovery of some light sensory.22 cases of non-fat flap, skin texture, color close to the neighboring skin with a sense recovery of pain, temperature and touching.2 patients with darker skin flaps, texture hard,1 case with a poor edge healing resulting in scar formation.2 cases of partial necrosis of skin graft donor sites, scar healing of skin flap crawling.Conclusion1. While human tissue transplantation may vary, taking into account of the principle of concerning both function and appearance in the redevelopment with the minimized harm for the offered as well as a simple operation if necessary, each patient must be carried out a personalized combination of flap selection and improvement and all types of flap indication should be strictly controlled.2. Considering the shortness of simple well-known vascular limbs of deep perforating artery branches as well as limited blood supply, a support vessel with the combination of neurocutaneous flap is to increase flap artery and to expand the selected size of the flap and repair areas. Moreover, skin perforator pedicled neurocutaneous vascular flap is to repair hand soft tissue defects with the characteristics of shallow flap position, moderate thickness, easy operation, not sacrificing the trunk blood vessels, a reliable blood supply, and the terminal sensory function reconstruction.3. In the clinical practice, the neighboring distal flap which may receive the same effect as a distant one may be taken into consideration first. Meanwhile, a non- vascularized flap which can receive the same effect as a flap with vascular anastomosis should be applied. A secondary site flap can only be used to repair those primary defect. It is necessary to consider the subject area of shape and function as well as the need to minimize the damage to the morphology and function of the donor site.4. Most of flap blood circulation disorder after surgery is mainly due to improper treatment. Premature weight-bearing may lead to poor healing of flap edge. The ulcers are very much related to post-operative infection. Post-operative infection, as well as scar formation may be one of those important causes of ulcers.